未明确诊断意义的不典型鳞状上皮细胞临床处理方法的探讨  

Study on the Clinical Management Strategy of ASCUS

作　　者：杨伶俐[1] 杨慧琳[1] 杜雪梅[1] 黄莉霞[1] 

机构地区：[1]上海市浦东新区妇幼保健院,上海201206

出　　处：《实用妇产科杂志》2011年第1期31-33,共3页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨宫颈液基细胞学检查(LCT)结果为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)的临床处理方法。方法:LCT检查结果为ASCUS的患者454例,将其随机分为3组:A组,151例,3月后复查LCT;B组,152例,随即进行高危型人乳头瘤病毒(HPV)检测;C组,151例,随即进行阴道镜检查,并在阴道镜下活检。比较3组ASCUS患者宫颈上皮内瘤变(CIN)的检出情况。结果:①A组复查LCT,细胞学异常(≥ASCUS)39例(25.83%),阴道镜下活检病理结果为宫颈炎24例,CINⅠ5例,CINⅡ9例,CINⅢ1例。95例复查LCT正常者阴道镜下活检,病理结果为宫颈炎88例,CINⅠ4例,CINⅡ2例,CINⅢ1例。②B组有60例(39.47%)高危型HPV检测阳性,其阴道镜下活检病理结果为宫颈炎32例,CINⅡ13例,CINⅡ13例,CINⅢ2例。80例HPV阴性者阴道镜下活检,病理均为宫颈炎。③C组151例ASCUS直接进行阴道镜检查及阴道镜下活检,病理结果为宫颈炎115例,CINⅠ12例,CINⅡ18例,CINⅢ6例。④复查LCT和检测高危型HPV对预测ASCUS患者中宫颈高级别病变的准确性差异无统计学意义(P>0.05)。结论:复查LCT是有效的分流ASCUS的方法。对于依从性差或高危人群,宜作高危型HPV检测进行分流,或直接行阴道镜检查及镜下活检明确诊断,随即作相应处理。Objective：To study the clinical management strategy of atypical squamous cells of undetermined significance （ASCUS） diagnosed by cervical liquid-based cytology test （LCT）. Methods：454 ASCUS were found by LCT and were divided into 3 groups randomly. 151 ASCUS in group A, had repeated LCT in 3 month ;152 ASCUS in group B,had high-risk human papilloma virus（HPV） testing immediately; 151 ASCUS in group C, had colposcopy and biopsy immediately. The detection of cervical intraepithelial neoplasia（CIN） in the three groups was analyzed. Results：①In group A, there were 39 （25.83%） abnormal results after repeated LCT（≥ASCUS）. For the 39 patients,their pathology results by biopsy under colposcopy were 24 cervicitis,5 CIN Ⅰ,9 CIN Ⅱ ,1 CIN Ⅲ. For the other 95 normal results,88 cervicitis,4 CIN Ⅰ ,2 CIN Ⅱ ,1 CIN Ⅲ were found by colposcopy. ②ln group B,60（39.47% ） patients had positive HPV test result,their pathology results by biopsy under colposcopy were 32 cervicitis,13 CIN Ⅰ,13 CIN Ⅱ ,2 CIN Ⅲ. No CIN was found when HPV test was negative.③ln group C,the biopsy results were 115 cervicitis,12 CIN Ⅰ,18 CIN Ⅱ ,6 CIN Ⅲ.④ To detect the high grade CIN by repeated LCT or high-risk HPV testing,there was no statistical difference （P〉0.05）. Conclusions： Repeated LCT is efficient in triage of ASCUS. For the women without obliability or having high risk factors, HPV testing or colposcopy and biospy is necessary.

关 键 词：未明确诊断意义的不典型鳞状上皮细胞 人乳头瘤病毒 液基细胞学检查 宫颈上皮内瘤变 

分 类 号：R711.74[医药卫生—妇产科学]